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Meth Hype Could Undermine Good Medicine

Overstating the dangers of methamphetamine may impede treatment of drug abusers, asserts a review by Columbia University researchers

The 1936 film Reefer Madness developed a cult following because of its over-the-top depiction of the evils of marijuana. Getting stoned and going to a midnight showing became a ritual for many college students.

The recognition that pot is not a direct route to an asylum for the criminally insane, as it was for one character in the film, fueled the hilarity for late-night moviegoers. The divergence between perception and reality has become an issue in recent years for other recreational drugs.

Last month four scientists from Columbia University published an analysis of previous studies on methamphetamine use that called into question some of the purported damaging effects of the drug on brain functioning. The review in Neuropsychopharmacology found that short-term effects of the drug actually improve attention, as well as visual and spatial perception, among other things.

Moreover, chronic users—the ones who would be expected to suffer most—remain largely unimpaired. The researchers found that they experience brain and cognitive changes “on a minority of measures” in brain imaging and psychological tests. “Cognitive functioning overwhelmingly falls within the normal range,” the report states, while adding that researchers’ pre-existing assumptions about meth's detrimental effects "should be reevaluated to document the actual pattern of cognitive effects caused by the drug."

While recognizing the potential for abuse, the researchers emphasize that misinterpretations of the scientific evidence can wrongly stigmatize drug abusers and lead to misguided policymaking. One study, for instance, asserted that meth abusers might be too cognitively damaged to benefit from rehabilitative treatments, such as cognitive behavioral therapies. “Findings from this review argue that such concerns are unwarranted,” the researchers state.

In Thailand, efforts to stem meth use have gone as far as banning all amphetamines, a class of drug that is used medically for treatment of ADHD and other conditions. “My main goal really was to make sure that we are rigorous in the science before we are political,” says Carl Hart, a substance abuse researcher at Columbia who was the lead author on the Neuropsychopharmacology paper. “I think, with meth, we have been political.” (Neuropsychopharmacology is part of Nature Publishing Group, which also includes Scientific American.)

The article asserts that some of the misconceptions surrounding meth go beyond findings on mental functioning. Drug education campaigns often publish photographs of “meth mouth,” severe tooth decay among users because of the lack of saliva. But dry mouth is a condition common to other drugs, such as the prescription antidepressant Cymbalta and the ADHD medication Adderall.

Hart says he was impelled to do the research because of distortions of the evidence for harm from crack cocaine. During the crack cocaine epidemic in the 1980s and 1990s, pronouncements about lasting prenatal harm to children whose mothers used the drug turned out to be overblown: long-term effects on brain development and behavior were fairly small, and children were sometimes ostracized or received medical diagnoses that were mistakenly attributed to effects from the drug.

The review by Hart and colleagues elicited a firm counterpoint from National Institute on Drug Abuse director Nora Volkow, some of whose research is critiqued in the Neuropsychopharmacology paper. “Because of the far-reaching public health implications of this issue, it is essential not to forget what we do know about meth-induced neuropathology, which is plenty troubling,” she says. Volkow points out that the vascular effects of meth can lead to strokes and hemorrhages. The drug, she notes, has also been shown to produce inflammation, atrophy and structural changes in brain tissue. “Similarly worrisome is a recent report of increased incidence of Parkinson’s diseases among individuals with a past history of methamphetamine abuse [compared with] the general population,” she says, adding that meth abuse can be “neurotoxic to the human brain.”

Hart responds that he and his colleagues were careful to consider the full body of scientific literature, including animal studies. He points out that many animal studies used to extrapolate possible deleterious cognitive effects in humans had administered large amounts of methamphetamine from the outset, a regimen unlike the gradual escalation in dosing undertaken by illicit drug users, which avoids these consequences. The article emphasizes that serious medical consequences, such as paranoia and hypertension leading to stroke, are rare and only result from sustained ingestion of very large doses.

Meth’s persistent bad boy reputation means that medical marijuana dispensaries will not be expanding their offerings to include speed any time soon. Still, the idea is not as totally outlandish as it might seem.

A much cited commentary that appeared in Nature in December 2008—an article co-authored by neuroscientists and ethicists—raised the prospect of routine use of “cognitive enhancement” drugs by the general public if they could be proved safe.

The few drugs already on the market that come closest to meeting the definition of cognitive enhancers include Adderall (dextroamphetamine and amphetamine) and Ritalin (methylphenidate), close chemical cousins of methamphetamine. Ritalin and Adderall, in fact, have developed a reputation as executive’s little helpers in the business world and were cited in the Nature commentary.

Hart and his colleagues never suggested that methamphetamine could serve as a pick-me-up for meeting pending work deadlines. Their review, though, looked at more than 10 studies that found that short-term use of meth actually improves several cognitive measures, precisely the kind of evidence the authors of the Nature article were calling for when considering the merits of enhancement.

The debate over methamphetamine, used widely by soldiers during World War II, reveals the ambivalent societal relationship toward potentially addictive compounds that can also serve as performance boosters. The hate-love relationship will likely continue into the indefinite future.

There is some power that prevents people from getting the help needed I feel all substance abuse is the effort to just feel ok or self medicate. besides young people out to have a wild time. but those I know of that are older the mid 30's to 60's just want to be level headed not running at max. I was born depressed and used alcohal to relieve the pain but it was not helpfull over all. I had talents in art but no disire to practice or improve I had disire to learn about math science but could not sustain any period of appling my self just depressed that is untill I was about 50 years old. I read a article about Adult Atention Dissorder I was treated for it with Ritlan and was so overjoyed to find the key to my life long suffering. But then there was backlash about the use of "dangerous drug" and so I would go untreated for years seek out help go through the anti depresants thyroid counseling to satisfy drs then finaly I would get medication only to have it stoped after few months and back to the wasted days of life again it makes me so angery to think of the years of my life wasted and the last years still being wasted (age 65) because its near impossible to find any dr to treat AADD I spent thousands on help groups and ADD org. But its endless circle of treatment promises and dead end promises. Why? I now can get Aderal but the dr charges $360 per visit and the presciption is very costly so about every 6 months I can get the medication that I make last about 2 months and then back to the past. I hope to find help on this fourm. I apologise for the terrible spelling but its somthing I have never done well at and ADD has made me function at very low levels but on the the med I can remember and write at near collage levels. This is my first post and I know its very long but I want to put my story out here and hope it may stike a chord with others like me.

I was always curious about this topic and hoped to get involved in some research later down the road on the topic.

My curiosity was sparked thinking about whether possible negative effects found from methamphetamine use were not in fact caused by the drug and had more to do with the route of administration (ROA). Polydrug abuse makes it nearly impossible to parse out the effects of drug cocktails and other drugs of abuse. But it would be interesting to look at differences between those who smoke meth, those who IV it, and those who take it orally. My hypothesis was that the smoke in meth would show negative outcomes and all others would show no difference compared to healthy controls.

I had a little trouble conducting a literature search on the topic. But I was always curious about the contents of methamphetamine vapor. Whether it contained a chemical or chemicals that when inhaled, would damage the lungs and perhaps affect the brain. I don't have literature at the moment to even support this hypothesis. I came up with it when talking to a researcher looking at neurocognitive effects of methamphetamine in a prison population.

I would also be curious to see whether cigarette smoking also effects the likelihood that fast acting ROAs like IV and smoking may effect cognition. Cigarettes release monoamines and inhibit the enzyme that breaks them down (MAO-B). I would hypothesize habitual users of cigarettes may experience more negative effects than habitual smokers. Again, neither of these are being researched at the moment. I am just oober curious.

Just some general thoughts. But I have always wondered why they have demonized meth. The media has done a fantastic job of hyping people up. There seems to be a lot of misconceptions about certain drugs and even general researchers in the field are falling victim to these effects. I was very disappointed in the newest version of my favorite authors of a psychopharmacology series. I really hope those in the field continue to stand up and make sure correct information is out there.